Provider Demographics
NPI:1407828304
Name:VESCERA, GIORGIO JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GIORGIO
Middle Name:JAMES
Last Name:VESCERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 PARKMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-1639
Mailing Address - Country:US
Mailing Address - Phone:330-898-1486
Mailing Address - Fax:330-898-4530
Practice Address - Street 1:2875 PARKMAN RD NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-1639
Practice Address - Country:US
Practice Address - Phone:330-898-1486
Practice Address - Fax:330-898-4530
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2510812Medicaid